Introduction The Macmillan Scottish Mesothelioma Network was launched in April 2019, funded by a consortium of partners, including Macmillan Cancer Support, Mesothelioma UK and NHS Greater Glasgow & Clyde. The network funds sessional time for Lead Clinicians, Clinical Nurse Specialists and administrative support in Glasgow, Edinburgh, Dundee, Aberdeen and Inverness, and coordinates a weekly video-linked MDT meeting. We retrospectively reviewed MDT activity and outcomes over the first 12 months of operations.
Methods All 42 MDTs held between 12.4.19–03.4.20 were reviewed retrospectively, using referral and MDT documentation and electronic case records.
Results 223 patients from 25 Scottish hospitals were referred, prompting 331 case discussions. 89% (n=199) were male. The median age was 74 years. 140/223 (63%) patients described asbestos exposure. 181/223 patients were diagnosed with Mesothelioma. Performance status was recorded in 210/223 94% of cases, and was 0–1 in 148/223 (66%). 203/223 (91%) had histological sampling, which was definitive in 198/203 (98%) patients, via the following methods: Surgical Thoracoscopy (64/203 (32%)), Local Anaesthetic Thoracoscopy (54/203 (27%)), image-guided biopsy (63/203 (31%)), Abrams biopsy (6/203 (3%)), unrecorded (16/203 (8%)). Standard histology was supplemented by molecular studies in 34% cases (BAP1 in 59/203 (29%): P16 FISH in 37/203 (18%) resulting in the following sub-typing: Epithelioid (68%), Biphasic (13%), Sarcomatoid (12%), Desmoplastic (2.4%), Undifferentiated (1.2%) Transitional (0.6%). Disease stage was recorded 87% of MPM cases (54% stage 1, 10% stage II, 24% stage III, 12% stage IV). 16/203 (8%) patients had Peritoneal mesothelioma.
Clinical trials, including MARS2, CONFIRM, ATOMIC-Meso, INFINITE, SYSTEMS2, TRIZELL, MESO-Trap were recommended in 84/181 (46%) patients. 26/84 (31%) patients were recruited, most frequently to MARS2 trial, representing 16% of the MPM population. A Palliative Care specialist was present for 32/42 (76%) MDT meetings, facilitating direct palliative care referral in 52/223 (23%) patients.
Conclusion This review demonstrates the value of a fully funded national clinical network and associated MDT. Over the first 12 months of operation the network has provided high quality diagnostic services and a consistent approach to therapeutic options, based on international guidelines. Ensuring equitable access to a broad portfolio of clinical trials will remain a major priority for the network.
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